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Sunday, July 6, 2014

An Unusual Spay?

Patty sent me the following email.....
Here's a question for you. Back in 1990, I had a female JRT puppy that I brought to the vet to be fixed, she was 6 mos old at the time. I've grown up with dogs so I was a bit familiar with what to expect when picking her up the next day.

When I came into her office area to pick up my dog Trixie, the doctor handed her to me in my arms, limp and her abdomen was covered in blood! I took one look at her, then looked at the doctor, walked up to her very closely, stared her in the face and said, "What did you do to my dog?!" She said what do you mean? I said, "she's limp and covered in blood! What did you do?" She said, "Well, you have to understand this is a very big operation for a little dog and it's going to take time for her to recover. As for the blood, dogs like to lick the blood off themselves, so we don't clean them off." I said to her, "Give me my dog, I'm NEVER coming back here!" I paid the office and never went back.

When I got Trixie home, I took a look at her incision. There were sutures that I've NEVER seen before. They looked like metal twist ties that you'd see on a loaf of bread (if you took the paper off the twist ties). There were three of them holding the incision together. I was suppose to bring Trixie back to that vet to have the twist ties removed. The odd thing was, one day I checked her incision and they were gone. I never found them. There weren't on the floor and I'm pretty sure Trixie didn't eat them - they were pointy metal twist ties and if she pooped them out I would have seen them.

Trixie was fine after her visit at that vet. We took her to another vet we liked and they cared for her for her entire life until we had to put her to sleep when she was 14 1/2 years old. I still miss her to this day.

But what to you think about her surgery? It seemed really bizarre to me!
I've been in practice since 1997, but I started working for a vet in 1984.  I remember what it was like back then and how spays were done.  First I want to point out that this incident was 24 years ago and thing were done a bit differently back then.  Nobody that I know of still uses the anesthesia or analgesia that was common at that time.  We have advanced considerably in our ability to make surgery safer and control pain better.  So any comments I make about this situation probably no longer apply.
Let me start at the end.  It sounds like this vet used metal sutures for the skin, which was not unheard of.  Most vets in the late 80s to early 90s were using nylon suture for the skin and various absorbable sutures for the rest of the surgery.  But doctors who preferred metal suture material were not doing anything that was not accepted by the profession.  Even when I graduated vet school I knew practices where this was normal.  This was a legitimate suture choice and one that would never have been considered malpractice, even if it wasn't common by then.  Uncommon?  Possibly.  "Bad"?  No.
I would take a little more issue with the condition in which the dog was brought out.  The vet that I grew up working for, Dr. John Strasser, gave me an incredible amount of guidance and wisdom.  One of the things that was important to him was to have the surgical site appear nice.  He told us that we needed to shave the fur very straight and even.  You might ask why, since an uneven clipping didn't affect the surgery in any way.  But he said that the incision and fur is all the clients see.  You might be the best surgeon in the world but the clients can't see what you did internally.  They might see an uneven clip and think "Well, if they can't even shave the fur in a straight line, what are they doing inside my dog?"  To him it was a matter of client perception.  He would never have allowed a dog to go home with blood on its skin.  And neither would I.  I've shared his wisdom in my years in practice and hold my staff to the same standards. 

I try not to bad-mouth vets if I haven't been directly involved in the situation, and I'm only hearing one side of this.  But if the vet actually did say that they deliberately left the blood so the dog could lick it off, that's not a good thing.  We absolutely, positively DO NOT want animals to lick at or around their incisions!  Even back then we would commonly recommend Elizabethan collars (cone collars) to prevent it from happening.  If a dog licks at their incision vigorously enough or persistently enough they can actually cause it to come open, or at the minimum cause an infection.  The last thing we want is for them to lick at it, so this is an odd statement for a vet to make.
I would want to know just how limp she was.  Anesthetics in the '90s tended to last longer in a dog's system and therefore you could get prolonged sedation.  The ones we use nowadays are removed from the body much faster.  Most of my patients are standing and walking within two hours after surgery, and typically go home with only minimal sedation.  Definitely not "limp"!  In fact, if any of my surgeries couldn't walk on their own, I'd want to keep them longer for observation.  I may define "limp" differently than Patty did.  If the dog was perfectly fine with normal vital signs, then this may just have been sedation from the anesthesia and pain medications.  But if the dog was extremely weak, limp-limbed, and couldn't support herself, it may have been a situation where she should have stayed longer to be more awake or make sure there were no other complications.
The practice I grew up working at, Kildaire Animal Medical Center in Cary, North Carolina, strived to be a very high quality practice.  Dr. Strasser knew that we were one of the higher priced vets in the area and wasn't ashamed of that.  But he told us that if we were going to charge those prices we darn well better give people service worth those prices.  That statement makes even more sense to me today!  Many people may not realize it or like it, but we're in a service industry.  This fact makes client service of utmost importance.  How a pet looks and acts when it goes home after surgery is a large part of this level of client service.
In the 30 years that I've been in and around veterinary medicine I've seen some big changes in how we practice and the medications we use.  We've advanced to the point that I would indeed have serious issues with a vet that in 2014 handled a spay like Patty's dog.  We are highly trained doctors and need to conduct ourselves as such and treat our patients in a professional manner.
I think Patty's story also illustrates a few important points.  First, not all vets do things the same, and not all surgeries are performed the same way.  Even something as routine as a spay will have some variations from clinic to clinic in the kind of drugs they use, suture material, anesthetic monitoring, and so on.  Second, always ask questions of your vet.  If something doesn't seem right to you, ask about it.  Please do so in a polite and open manner, rather than a confrontational or accusatory way, but do ask.  Any vet should be able to explain why and how they do anything.  If you don't like the answers or don't agree with them, you have the freedom to find another doctor.
Patty, I'm glad that she turned out to be fine and lived such a long life!